Is temporal artery thermometry a useful indicator of core body temperature in patients receiving general anesthesia

Anesthetic medications and the cold operating room environment are among the factors that increase the risk of decreased core body temperature in surgical patients, which can put a patient at risk for untoward physiologic responses. Therefore, peripheral thermometry methods, like the temporal artery thermometer, have been questioned as an accurate indicator of core body temperature. To determine the usefulness of the temporal artery thermometer in patients receiving general anesthesia, three specific aims were set. First, the study compared the accuracy of temporal artery temperature (Tat) to esophageal temperature (Tes) in estimating core body temperature in the operating room. Second, Tat’s accuracy was compared with oral temperature (Tor) in the post anesthesia care unit (PACU). Lastly, this study determined factors that were associated with the level of agreement between Tes and Tat from the beginning of anesthesia administration (induction time point) to the time the patient is awakened from anesthesia (emergence time point). A prospective repeated measures design was used at three time points (induction, emergence, and in the post-anesthesia care unit (PACU). Temperatures were collected in 54 surgical patients requiring general anesthesia and Tat was compared to Tes intraoperatively and Tor postoperatively. Data analysis included descriptive statistics, t-test comparison of temperatures, and generation of Bland Altman plots to examine the agreement between thermometry methods. Multiple linear regression was also used to identify factors associated with the agreement between methods. Results showed that Tes and Tor were all found to be statistically significant for being lower compared to Tat at all three time points. The temporal artery thermometer results produced overestimation of core body temperature paralleled with a poor ability to detect hypothermia. Additionally, the use of muscle relaxants and the location of the surgical site incision (torso compared to neck) were associated with the difference between Tat and Tes from induction to emergence. Therefore, although Tat is more convenient than other thermometry methods, the temporal artery thermometer should be substituted with better indicators of core body temperature to avoid risks of perioperative hypothermia, which is defined as a body temperature less than 36˚C

The net effects of medical malpractice tort reform on health insurance losses: the Texas experience

In this paper, we examine the influence of medical malpractice tort reform on the level of private health insurance company losses incurred. We employ a natural experiment framework centered on a series of tort reform measures enacted in Texas in 2003 that drastically altered the medical malpractice environment in the state. The results of a difference-in-differences analysis using a variety of comparison states, as well as a difference-in-difference-in-differences analysis, indicate that ameliorating medical malpractice risk has little effect on health insurance losses incurred by private health insurers

Heterogeneity within the Asian American community

BACKGROUND: Educational interventions are grounded on scientific data and assumptions about the community to be served. While the Pan Asian community is composed of multiple, ethnic subgroups, it is often treated as a single group for which one health promotion program will be applicable for all of its cultural subgroups. Compounding this stereotypical view of the Pan Asian community, there is sparse data about the cultural subgroups' similarities and dissimilarities. The Asian Grocery Store based cancer education program evaluation data provided an opportunity to compare data collected under identical circumstances from members of six Asian American cultural groups. METHODS: A convenience sample of 1,202 Asian American women evaluated the cultural alignment of a cancer education program, completing baseline and follow-up surveys that included questions about their breast cancer knowledge, attitudes, and screening behaviors. Participants took part in a brief education program that facilitated adherence to recommended screening guidelines. RESULTS: Unique recruitment methods were needed to attract participants from each ethnic group. Impressions gained from the aggregate data revealed different insights than the disaggregate data. Statistically significant variations existed among the subgroups' breast cancer knowledge, attitudes, and screening behaviors that could contribute to health disparities among the subgroups and within the aggregate Pan Asian community. CONCLUSION: Health promotion efforts of providers, educators, and policy makers can be enhanced if cultural differences are identified and taken into account when developing strategies to reduce health disparities and promote health equity